Two Males with Femoral Hernias Caused by Anatomical Changes after Inguinal Hernia Repair

Abstract

Femoral hernias are relatively rare and usually occur in elderly females. They are sometimes found in patients who have previously undergone inguinal hernia repair. We report the cases of two males with femoral hernias induced by anatomical changes after inguinal hernia repair. Both patients underwent laparoscopic transabdominal preperitoneal repair. Patient 1 was a 73-year-old man who had undergone mesh plug repair for a right inguinal hernia three months previously. Laparoscopy showed that the iliopubic tract was displaced superiorly due to contraction of Hesselbach's triangle by scar tissue where the mesh plug was placed. The inguinal ligament was displaced and the femoral ring expanded. Patient 2 was a 62-year-old man who underwent left inguinal hernia repair during childhood. Laparoscopy showed that the iliopubic tract was displaced, and the femoral ring expanded. We suggest that the posterior wall of the inguinal canal was damaged in the previous operation during high ligation of the hernial sac. In both patients, we consider that the traction forces used affected the inguinal ligament, resulting in expansion of the femoral ring and development of a femoral hernia.